purityselect/resources/js/views/pages/questionere/weight-loss-form.js
2024-10-25 01:05:27 +05:00

877 lines
18 KiB
JavaScript

export default {
steps: {
page0: {
elements: [
'h4_3',
'p',
'weight_loss_weight',
'weight_loss_height',
],
buttons: {
previous: false,
},
},
page1: {
elements: [
'h4_4',
'p_1',
'weight_loss_target_weight',
],
},
page2: {
elements: [
'h4_5',
'p_2',
'weight_loss_weight_changes_in_past',
'weight_loss_weight_changes_in_past_reason',
],
},
page3: {
elements: [
'h4',
'p_3',
'weight_loss_diagnosed_related_conditions',
'weight_loss_diagnosed_related_conditions_reason',
],
},
page4: {
elements: [
'h2',
'p_4',
'weight_loss_good_allergies',
'weight_loss_good_allergies_reason',
],
},
page5: {
elements: [
'h4_1',
'p_5',
'weight_loss_physical_activity_exercise',
],
},
page6: {
elements: [
'h4_2',
'p_6',
'weight_loss_used_medications_before',
'weight_loss_used_medications_before_explanation',
],
},
page7: {
elements: [
'h4_6',
'p_7',
'weight_loss_taking_affecting_medications',
'weight_loss_taking_affecting_medications_reason',
],
},
page8: {
elements: [
'h4_7',
'p_8',
'weight_loss_have_allergies_to_medications',
'weight_loss_have_allergies_to_medications_reason',
],
},
page9: {
elements: [
'h4_8',
'p_9',
'weight_loss_some_serious_conditions',
'weight_loss_some_serious_conditions_others',
],
},
page10: {
elements: [
'h4_9',
'p_10',
'weight_loss_history_gastrointestinal_disorders',
'weight_loss_history_gastrointestinal_disorders_reason',
],
},
page11: {
elements: [
'h4_10',
'p_11',
'weight_loss_diagnosed_with_any_hormonal_imbalances',
'weight_loss_diagnosed_with_any_hormonal_imbalances_reason',
],
},
page12: {
elements: [
'h4_11',
'p_12',
'weight_loss_consume_alcohol',
],
},
page13: {
elements: [
'h4_12',
'p_13',
'weight_loss_family_history_of_thyroid_cancer',
'weight_loss_family_history_of_thyroid_cancer_reason',
],
},
page14: {
elements: [
'h4_13',
'p_14',
'weight_loss_experienced_nausea_vomiting',
'weight_loss_experienced_nausea_vomiting_reason',
],
},
page15: {
elements: [
'h4_14',
'p_15',
'weight_loss_used_anti_inflammatory',
'weight_loss_used_anti_inflammatory_reason',
],
},
page16: {
elements: [
'h4_15',
'p_16',
'weight_loss_affecting_your_growth_hormone_levels',
'weight_loss_affecting_your_growth_hormone_levels_reason',
],
},
page17: {
elements: [
'h4_16',
'p_17',
'weight_loss_are_you_pregnant',
],
},
},
schema: {
h4_3: {
type: 'static',
tag: 'h4',
content: 'Weight Loss',
},
p: {
type: 'static',
tag: 'p',
content: 'What is your current weight and height?\n',
},
weight_loss_weight: {
type: 'text',
label: 'Weight (lbs or kg)',
inputType: 'number',
rules: [
'required',
],
},
weight_loss_height: {
type: 'text',
label: 'Height (feet/inches or cm)',
inputType: 'number',
rules: [
'required',
],
},
h4_5: {
type: 'static',
tag: 'h4',
content: 'Weight Loss',
},
p_2: {
type: 'static',
tag: 'p',
content: 'Have you experienced significant weight changes (gain/loss) in the past 6 months?',
},
weight_loss_weight_changes_in_past: {
type: 'radiogroup',
view: 'blocks',
items: [
{
value: 'Yes',
label: 'Yes',
description: '',
},
{
value: 'No',
label: 'No',
description: '',
},
],
rules: [
'required',
],
},
weight_loss_weight_changes_in_past_reason: {
type: 'text',
label: 'If yes, please describe.',
rules: [
'required',
],
conditions: [
[
'weight_loss_weight_changes_in_past',
'in',
[
'Yes',
],
],
],
},
h4_4: {
type: 'static',
tag: 'h4',
content: 'Weight Loss',
},
p_1: {
type: 'static',
tag: 'p',
content: 'What is your target weight?\n',
},
weight_loss_target_weight: {
type: 'text',
inputType: 'number',
rules: [
'required',
],
},
h4: {
type: 'static',
tag: 'h4',
content: 'Weight Loss',
},
p_3: {
type: 'static',
tag: 'p',
content: 'Have you been diagnosed with any weight-related conditions (e.g., obesity, metabolic syndrome, type 2 diabetes)?',
},
weight_loss_diagnosed_related_conditions: {
type: 'radiogroup',
view: 'blocks',
items: [
{
value: 'Yes',
label: 'Yes',
description: '',
},
{
value: 'No',
label: 'No',
description: '',
},
],
rules: [
'required',
],
},
weight_loss_diagnosed_related_conditions_reason: {
type: 'text',
label: 'If yes, please specify the condition.',
conditions: [
[
'weight_loss_diagnosed_related_conditions',
'in',
[
'Yes',
],
],
],
rules: [
'required',
],
},
h2: {
type: 'static',
tag: 'h4',
content: 'Weight Loss',
},
p_4: {
type: 'static',
tag: 'p',
content: 'Do you have any known food allergies or intolerances?',
},
weight_loss_good_allergies: {
type: 'radiogroup',
view: 'blocks',
items: [
{
value: 'Yes',
label: 'Yes',
description: '',
},
{
value: 'No',
label: 'No',
description: '',
},
],
rules: [
'required',
],
},
weight_loss_good_allergies_reason: {
type: 'text',
label: 'If yes, please specify the condition.',
rules: [
'required',
],
conditions: [
[
'weight_loss_good_allergies',
'in',
[
'Yes',
],
],
],
},
h4_1: {
type: 'static',
tag: 'h4',
content: 'Weight Loss',
},
p_5: {
type: 'static',
tag: 'p',
content: 'How often do you engage in physical activity or exercise?',
},
weight_loss_physical_activity_exercise: {
type: 'radiogroup',
view: 'blocks',
items: [
{
value: 'Never',
label: 'Never',
description: '',
},
{
value: '1-2 times a week',
label: '1-2 times a week',
description: '',
},
{
value: '3-4 times a week',
label: '3-4 times a week',
description: null,
},
{
value: '5+ times a week',
label: '5+ times a week',
description: null,
},
],
rules: [
'required',
],
},
h4_2: {
type: 'static',
tag: 'h4',
content: 'Weight Loss',
},
p_6: {
type: 'static',
tag: 'p',
content: 'Have you used medications for weight loss before?',
},
weight_loss_used_medications_before: {
type: 'radiogroup',
view: 'blocks',
items: [
{
value: 'Yes',
label: 'Yes',
description: '',
},
{
value: 'No',
label: 'No',
description: '',
},
],
rules: [
'required',
],
},
weight_loss_used_medications_before_explanation: {
type: 'text',
label: 'If yes, what medications have you tried, and were they effective?',
conditions: [
[
'weight_loss_used_medications_before',
'in',
[
'Yes',
],
],
],
rules: [
'required',
],
},
h4_6: {
type: 'static',
tag: 'h4',
content: 'Weight Loss',
},
p_7: {
type: 'static',
tag: 'p',
content: 'Are you taking medications that may affect your weight (e.g., insulin, antidepressants, thyroid medication)?\n',
},
weight_loss_taking_affecting_medications: {
type: 'radiogroup',
view: 'blocks',
items: [
{
value: 'Yes',
label: 'Yes',
description: '',
},
{
value: 'No',
label: 'No',
description: '',
},
],
rules: [
'required',
],
},
weight_loss_taking_affecting_medications_reason: {
type: 'text',
label: 'If yes, please specify',
rules: [
'required',
],
conditions: [
[
'weight_loss_taking_affecting_medications',
'in',
[
'Yes',
],
],
],
},
h4_7: {
type: 'static',
tag: 'h4',
content: 'Weight Loss',
},
p_8: {
type: 'static',
tag: 'p',
content: 'Do you have any known sensitivities or allergies to peptides or other medications?',
},
weight_loss_have_allergies_to_medications: {
type: 'radiogroup',
view: 'blocks',
items: [
{
value: 'Yes',
label: 'Yes',
description: '',
},
{
value: 'No',
label: 'No',
description: '',
},
],
rules: [
'required',
],
},
weight_loss_have_allergies_to_medications_reason: {
type: 'text',
label: 'If yes, please specify the condition.',
rules: [
'required',
],
conditions: [
[
'weight_loss_have_allergies_to_medications',
'in',
[
'Yes',
],
],
],
},
h4_8: {
type: 'static',
tag: 'h4',
content: 'Weight Loss',
},
p_9: {
type: 'static',
tag: 'p',
content: 'Do you have any of the following conditions?',
},
weight_loss_some_serious_conditions: {
type: 'radiogroup',
view: 'blocks',
items: [
{
value: 'Type 2 diabetes',
label: 'Type 2 diabetes',
description: '',
},
{
value: 'High blood pressure (Hypertension)',
label: 'High blood pressure (Hypertension)',
description: '',
},
{
value: 'Heart disease',
label: 'Heart disease',
description: null,
},
{
value: 'Thyroid disorders',
label: 'Thyroid disorders',
description: null,
},
{
value: 'Liver or kidney disease',
label: 'Liver or kidney disease',
description: null,
},
{
value: 'Other chronic conditions',
label: 'Other chronic conditions',
description: null,
},
],
},
weight_loss_some_serious_conditions_others: {
type: 'text',
label: 'Write other conditions',
rules: [
'required',
],
conditions: [
[
'weight_loss_some_serious_conditions',
'in',
[
'Other chronic conditions',
],
],
],
},
h4_9: {
type: 'static',
tag: 'h4',
content: 'Weight Loss',
},
p_10: {
type: 'static',
tag: 'p',
content: 'Do you have a history of gastrointestinal disorders (e.g., GERD, IBS, or gallbladder issues)?',
},
weight_loss_history_gastrointestinal_disorders: {
type: 'radiogroup',
view: 'blocks',
items: [
{
value: 'Yes',
label: 'Yes',
description: '',
},
{
value: 'No',
label: 'No',
description: '',
},
],
rules: [
'required',
],
},
weight_loss_history_gastrointestinal_disorders_reason: {
type: 'text',
label: 'If yes, please describe',
rules: [
'required',
],
conditions: [
[
'weight_loss_history_gastrointestinal_disorders',
'in',
[
'Yes',
],
],
],
},
h4_10: {
type: 'static',
tag: 'h4',
content: 'Weight Loss',
},
p_11: {
type: 'static',
tag: 'p',
content: 'Have you been diagnosed with any hormonal imbalances that affect weight (e.g., hypothyroidism, Cushing\'s syndrome)?',
},
weight_loss_diagnosed_with_any_hormonal_imbalances: {
type: 'radiogroup',
view: 'blocks',
items: [
{
value: 'Yes',
label: 'Yes',
description: '',
},
{
value: 'No',
label: 'No',
description: '',
},
],
},
weight_loss_diagnosed_with_any_hormonal_imbalances_reason: {
type: 'text',
label: 'If yes, please describe',
rules: [
'required',
],
conditions: [
[
'weight_loss_diagnosed_with_any_hormonal_imbalances',
'in',
[
'Yes',
],
],
],
},
h4_11: {
type: 'static',
tag: 'h4',
content: 'Weight Loss',
},
p_12: {
type: 'static',
tag: 'p',
content: 'Do you consume caffeine, nicotine, or alcohol?',
},
weight_loss_consume_alcohol: {
type: 'radiogroup',
view: 'blocks',
items: [
{
value: 'Yes',
label: 'Yes',
description: '',
},
{
value: 'No',
label: 'No',
description: '',
},
],
},
h4_12: {
type: 'static',
tag: 'h4',
content: 'Weight Loss',
},
p_13: {
type: 'static',
tag: 'p',
content: 'Do you have a personal or family history of thyroid cancer or multiple endocrine neoplasia (MEN2)?',
},
weight_loss_family_history_of_thyroid_cancer: {
type: 'radiogroup',
view: 'blocks',
items: [
{
value: 'Yes',
label: 'Yes',
description: '',
},
{
value: 'No',
label: 'No',
description: '',
},
],
rules: [
'required',
],
},
weight_loss_family_history_of_thyroid_cancer_reason: {
type: 'text',
label: 'If yes, please describe',
rules: [
'required',
],
conditions: [
[
'weight_loss_family_history_of_thyroid_cancer',
'in',
[
'Yes',
],
],
],
},
h4_13: {
type: 'static',
tag: 'h4',
content: 'Weight Loss',
},
p_14: {
type: 'static',
tag: 'p',
content: 'Have you experienced nausea, vomiting, or digestive issues in the past while using weight loss medications?',
},
weight_loss_experienced_nausea_vomiting: {
type: 'radiogroup',
view: 'blocks',
items: [
{
value: 'Yes',
label: 'Yes',
description: '',
},
{
value: 'No',
label: 'No',
description: '',
},
],
},
weight_loss_experienced_nausea_vomiting_reason: {
type: 'text',
rules: [
'required',
],
conditions: [
[
'weight_loss_experienced_nausea_vomiting',
'in',
[
'Yes',
],
],
],
label: 'If yes, please specify the medication and side effects',
},
h4_14: {
type: 'static',
tag: 'h4',
content: 'Weight Loss',
},
p_15: {
type: 'static',
tag: 'p',
content: 'Have you ever used anti-inflammatory or immune-modulating medications, such as Amlexanox?',
},
weight_loss_used_anti_inflammatory: {
type: 'radiogroup',
view: 'blocks',
items: [
{
value: 'Yes',
label: 'Yes',
description: '',
},
{
value: 'No',
label: 'No',
description: '',
},
],
},
weight_loss_used_anti_inflammatory_reason: {
type: 'text',
label: 'If yes, please describe the effects:',
rules: [
'required',
],
conditions: [
[
'weight_loss_used_anti_inflammatory',
'in',
[
'Yes',
],
],
],
},
h4_15: {
type: 'static',
tag: 'h4',
content: 'Weight Loss',
},
p_16: {
type: 'static',
tag: 'p',
content: 'Have you been diagnosed with conditions affecting your growth hormone levels (e.g., growth hormone deficiency)?',
},
weight_loss_affecting_your_growth_hormone_levels: {
type: 'radiogroup',
view: 'blocks',
items: [
{
value: 'Yes',
label: 'Yes',
description: '',
},
{
value: 'No',
label: 'No',
description: '',
},
],
rules: [
'required',
],
},
weight_loss_affecting_your_growth_hormone_levels_reason: {
type: 'text',
label: 'If yes, please describe',
rules: [
'required',
],
conditions: [
[
'weight_loss_affecting_your_growth_hormone_levels',
'in',
[
'Yes',
],
],
],
},
h4_16: {
type: 'static',
tag: 'h4',
content: 'Weight Loss',
},
p_17: {
type: 'static',
tag: 'p',
content: 'Are you Pregnant? (Female Specific)',
},
weight_loss_are_you_pregnant: {
type: 'radiogroup',
view: 'blocks',
items: [
{
value: 'Yes',
label: 'Yes',
description: '',
},
{
value: 'No',
label: 'No',
description: '',
},
],
},
},
};